Impacto de la COVID-19 sobre los indicadores hospitalarios: análisis de los grupos relacionados por el diagnóstico en un servicio de cirugía vascular / Impact of COVID-19 on key performance indicators: analysis of diagnosis related groups in a vascular surgery department

Objetivos: evaluar el impacto de la pandemia por la COVID-19 sobre una serie de indicadores funcionaleshospitalarios mediante el uso de grupos relacionados por el diagnóstico (GRD). Comparar los resultados del Servicio de Angiología, Cirugía Vascular y Endovascular (ACV) del Hospital Universitario de Cabueñes (HUCAB) con la base de datos del Ministerio de Sanidad.Material y métodos: altas hospitalarias del servicio de ACV del HUCAB durante los años 2019, 2020 y 2021. Se utilizó el sistema all patients refined (APR)-GRD para la codificación de altas. Los indicadores clave estudiados fueron: número de altas, mortalidad, estancia media (EM) y peso medio (PM) del GRD. Se estudiaron los resultados globales por año y en función de los GRD más prevalentes. Los resultados obtenidos se cotejaron con los datos anuales de la codifi cación del conjunto mínimo básico de datos (CMBD) del Ministerio de Sanidad. Se analizó también la EM ajustada por el funcionamiento del estándar (EMAF) y por la casuística (EMAC), el índice de EM ajustada (IEMA), el índice funcional (IF) y casuístico (IC) y el número de estancias evitables.Resultados:el número de altas en 2020 disminuyó un 10 % respecto a 2019. Las altas ligadas a ingresos desde Urgencias aumentaron en el GRD 181 más de un 50 % durante el año 2020 y más del 100 % en el año 2021 con respecto a 2019. Respecto a la mortalidad, no se constató un aumento signifi cativo de forma global. La EM disminuyó un 20 % en 2020 y un 18 % en 2021 respecto a 2019. El PM aumentó de forma progresiva hasta alcanzar una media de 7,7 % en 2021. La EMAF fue superior a la EM estándar y el número de estancias ahorradas fue superior al esperado.Conclusiones: la pandemia por la COVID-19 ha infl uido sobre los indicadores hospitalarios estudiados: han disminuido el número de altas y la EM y ha aumentando el PM de los GRD. El número de estancias evitables ahorradas ha sido mayor que el estándar.(AU)

Objectives: to evaluate the impact of the COVID-19 on the hospital key performance indicators using the diagnosis-related groups (DRG). To compare the results of the Angiology and Vascular Surgery Department of the University Hospital of Cabueñes (HUCAB) with the database of the Ministry of Health.Material and methods: hospital discharges from the Vascular Surgery Department of the HUCAB during theyears 2019, 2020 and 2021. All patients refined (APR)-DRG system was extracted for discharge coding. The hospital key indicators studied were: number of discharges, mortality, mean stay (EM) and mean weight (PM) of the DRG. The overall results per year and according to the most prevalent DRGs were studied. The results obtained were compared with the annual data from the coding of the Minimum Basic Data Set (CMBD) of the Ministry of Health. The configured EM by adjusting the performance of the standard (EMAF) and by the casuistry (EMAC), the index of the adjusted EM (IEMA), the functional index (FI), casuistic index (CI) and the number of avoidable hospital stays were also analyzed. Results: number of discharges: it was 10 % inferior in 2020 compared to 2019. Discharges of the GRD 181 linked to admissions from the Emergency increased more than 50 % during 2020 and more than 100 % in 2021 compared to 2019. Mortality: there was no significant increase. EM: it decreased 20 % in 2020 and 18 % in 2021, compared to 2019. PM: it increased progressively to 7.7% on average in 2021. EMAF: it was superior to standard EM. The number of stays saved was higher than expected. Conclusions: the pandemic of COVID-19 influenced the hospital key performance indicators studied, reducing the number of discharges and ME and increasing the PM of the DRGs. The number of avoidable stays saved was greater than the standard.(AU)

Preoperative predictive factors for type II endoleak: Trying to define high-risk patients.

OBJECTIVE: Type 2 endoleaks (T2E) continue to be the "Achilles Heel" of endovascular aneurysm repair (EVAR). The aim of this study is to analyze preoperative factors of patients who underwent EVAR to define risk factors for T2E. METHODS: From January 2015 to June 2020, 140 of 191 patients who underwent EVAR in our institution meet inclusion criteria for this study. Postoperative image control were performed using duplex ultrasound or CT scan. All T2E detected during follow-up were confirmed by angio CT. Preoperative anatomic and clinical variables were analyzed for T2E using t-test, Mann-Whitney U test and Fisher exact test. ROC curves and the corresponding area under the curve (AUC) were used to describe the predictive accuracy for endoleak. RESULTS: T2E was detected in 16 patients (11.43%)0.12 of them (75%) were persistent and 10 (62.5%) provoked sac enlargement. Predictive factors for T2E were a greater IMA diameter (2.5 ± 0.5 vs. 3.3 ± 0.5, p < 0.001) and an increasing number of LA (4.8 ± 1.6 vs. 6.7 ± 1.4, p < 0.001). ROC curve analysis stablished thresholds of 3.5 mm for IMA diameter (sensitivity 77%, specificity 86%) and 5.5 for patent LA (sensitivity 88%, specificity 59%) as risk factor to develop T2E. CONCLUSIONS: Preoperative aortic side branches embolization to avoid T2E is not still standarised. We tried to define a group of high-risk patients for T2E. According to our findings, patients with a preoperative IMA> 3 mm and more than 5 patent LA should be considered for pre-EVAR embolization.

SARS-CoV-2 Positivity, Stent Thrombosis, and 30-day Mortality in STEMI Patients Undergoing Mechanical Reperfusion.

SARS-Cov-2 has been suggested to promote thrombotic complications and higher mortality. The aim of the present study was to evaluate the impact of SARS-CoV-2 positivity on in-hospital outcome and 30-day mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) enrolled in the International Survey on Acute Coronary Syndromes ST-segment elevation Myocardial Infarction (ISACS-STEMI COVID-19 registry. The 109 SARS-CoV-2 positive patients were compared with 2005 SARS-CoV-2 negative patients. Positive patients were older (P = .002), less often active smokers (P = .002), and hypercholesterolemic (P = .006), they presented more often later than 12 h (P = .037), more often to the hub and were more often in cardiogenic shock (P = .02), or requiring rescue percutaneous coronary intervention after failed thrombolysis (P < .0001). Lower postprocedural Thrombolysis in Myocardial Infarction 3 flow (P = .029) and more thrombectomy (P = .046) were observed. SARS-CoV-2 was associated with a significantly higher in-hospital mortality (25.7 vs 7%, adjusted Odds Ratio (OR) [95% Confidence Interval] = 3.2 [1.71-5.99], P < .001) in-hospital definite in-stent thrombosis (6.4 vs 1.1%, adjusted Odds Ratio [95% CI] = 6.26 [2.41-16.25], P < .001) and 30-day mortality (34.4 vs 8.5%, adjusted Hazard Ratio [95% CI] = 2.16 [1.45-3.23], P < .001), confirming that SARS-CoV-2 positivity is associated with impaired reperfusion, with negative prognostic consequences.

COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction.

OBJECTIVE: The initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days). METHODS: This is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality. RESULTS: In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p<0.0001). This reduction was significantly associated with age, being higher in older adults (>75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (p<0.001). Furthermore, the pandemic was associated with a significant increase in door-to-balloon time (40 (25-70) min vs 40 (25-64) min, p=0.01) and total ischaemia time (225 (135-410) min vs 196 (120-355) min, p<0.001), which may have contributed to the higher in-hospital (6.5% vs 5.3%, p<0.001) and 30-day (8% vs 6.5%, p=0.001) mortality observed during the pandemic. CONCLUSION: Percutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic. TRIAL REGISTRATION NUMBER: NCT04412655.

Outcomes of predefined optimisation criteria for intravascular ultrasound guidance of left main stenting.

AIMS: This study sought to investigate the prognostic effect of a protocol with optimisation targets for intravascular ultrasound (IVUS)-guided left main (LM) revascularisation. METHODS AND RESULTS: A protocol was prospectively applied for IVUS-guided LM revascularisation (IVUS-PRO group) including predefined optimisation targets. Using propensity score matching, we selected as control groups patients with angiography-guided PCI (ANGIO group) and IVUS-guided PCI (IVUS group) from a large multicentre registry. The primary endpoint was a composite of cardiac death, LM-related infarction and LM revascularisation at 12 months. In each group, 124 patients with comparable characteristics were included. The incidence of the primary outcome was significantly higher in the ANGIO group compared to the IVUS-PRO group (12.9% vs 4.8%, HR 0.35, 95% CI: 0.15 to 0.82, p=0.02), but not with respect to the IVUS group (12.9% vs 8%, HR 0.51, 95% CI: 0.20 to 1.22, p=0.1), driven by a lower rate of LM revascularisation (8% in the ANGIO group, 6.4% in the IVUS group and 3.2% in the IVUS-PRO group). IVUS-PRO resulted in being an independent risk predictor (HR 0.45, 95% CI: 0.15 to 0.98; p=0.041). CONCLUSIONS: IVUS guidance of LM stenting provides prognostic benefit with respect to the use of angiography alone, particularly when following a protocol with these predefined optimisation criteria.

Sarcoma sinovial pericárdico primario: un reto clínico / Primary pericardial synovial sarcoma. A clinical challenge

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A propósito de la desensibilización rápida al ácido acetilsalicílico de pacientes con cardiopatía isquémica. Respuesta / About rapid aspirin desensitization in coronary artery disease patients. Response

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Desensibilización rápida al ácido acetilsalicílico de pacientes con cardiopatía isquémica: experiencia de un centro / Rapid desensitization to aspirin in patients with coronary artery disease: A single center experience

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Seguimiento a largo plazo tras el tratamiento percutáneo del tronco coronario izquierdo no protegido en pacientes de alto riesgo no aptos para cirugía de revascularización / Long-term follow-up after percutaneous treatment of the unprotected left main stenosis in high risk patients not suitable for bypass surgery

Introducción y objetivos. La intervención coronaria percutánea en pacientes con estenosis de tronco coronario izquierdo no protegido se recomienda en los casos que no son candidatos a cirugía de revascularización aortocoronaria. El seguimiento a largo plazo de estos pacientes continúa siendo incierto. Métodos. Se incluyó en el estudio a todos los pacientes consecutivos con un nuevo diagnóstico de estenosis de tronco coronario izquierdo no protegido tratados con implantación de stents. La indicación de la intervención coronaria percutánea se estableció según los criterios de asistencia estándar, teniendo en cuenta las condiciones clínicas y anatómicas desfavorables para la utilización de la cirugía de revascularización aortocoronaria. El objetivo de valoración principal es la aparición de eventos cardiacos adversos mayores, incluidos los casos de muerte, infarto agudo de miocardio no mortal y revascularización de la lesión diana. Resultados. Se incluyó en el análisis a un total de 226 pacientes consecutivos, de los que se trató a 202 (89,4%) con implantación de stents liberadores de fármacos. La media de edad era 72,1 años, el 41,1% de los pacientes tenían disfunción renal y las medias de la puntuación SYNTAX y del EuroSCORE fueron 28,9 y 7,4 respectivamente. Se alcanzó éxito angiográfico en el 99,6% de los pacientes y éxito de la intervención en el 92,9%. A los 3 años, las tasas de eventos cardiacos adversos mayores, muerte, infarto agudo de miocardio no mortal y revascularización de la lesión diana fueron del 36,2, el 25,2, el 8,4 y el 8,0% respectivamente. La revascularización de la lesión diana se observó con mayor frecuencia en los casos en que se habían implantado ≥ 2 stents, en comparación con los pacientes en quienes se había utilizado un solo stent (el 18,5 frente al 5,8%; p=0,03), así como en los pacientes en quiens se utilizaron stents metálicos sin recubrimiento, en comparación con los tratados con stents liberadores de fármacos (el 13,0% frente al 7,9%; p=0,24). Se observó una trombosis de stent definida en 2 pacientes (0,9%) y una trombosis de stent probable en 7 (3,1%). El sexo femenino, el deterioro de la función del ventrículo izquierdo y el uso de stents sin recubrimiento mostraron una relación significativa con la mortalidad por todas las causas. Conclusiones. Los pacientes de alto riesgo con una estenosis de tronco coronario izquierdo no protegido tratados con una intervención coronaria percutánea presentaron una tasa elevada de eventos cardiacos adversos mayores en el seguimiento a largo plazo. El sexo femenino, el deterioro de la función del ventrículo izquierdo y el uso de stents sin recubrimiento fueron factores predictivos de mal pronóstico (AU)

Introduction and objectives. Percutaneous coronary intervention is recommended in patients with unprotected left main stenosis non suitable for coronary artery bypass graft. Long-term follow-up of those patients remains uncertain. Methods. All patients with de novo unprotected left main stenosis treated with stent implantation were consecutively enrolled. Percutaneous coronary intervention was indicated according to the standards of care, taking into account clinical and anatomical conditions unfavorable for coronary artery bypass graft. The primary end point was the occurrence of major adverse cardiac events, a composite of death, nonfatal acute myocardial infarction, or target lesion revascularization. Results. Of 226 consecutive patients included, 202 (89.4%) were treated with drug-eluting stents. Mean age was 72.1 years, 41.1% had renal dysfunction, and mean Syntax score and EuroSCORE were 28.9 and 7.4, respectively. Angiographic and procedural success was achieved in 99.6% and 92.9% of patients. At 3.0 years, the rates of major adverse cardiac events, death, nonfatal acute myocardial infarction and target lesion revascularization were 36.2%, 25.2%, 8.4%, 8.0%, respectively. Target lesion revascularization was more frequently observed when ≥2 stents were implanted rather than a single stent (18.5% vs 5.8%, P=.03); and with bare metal stents rather than drug-eluting stents (13.0% vs 7.9%, P=.24). Definite stent thrombosis was observed in 2 patients (0.9%) and probable stent thrombosis in 7 (3.1%). Female sex, impaired left ventricular function, and use of bare metal stents were significantly related with all-cause mortality. Conclusions. High-risk patients with unprotected left main stenosis treated with percutaneous coronary intervention presented with a high rate of major adverse cardiac events at long-term follow-up. Female sex, impaired left ventricular function, and use of bare metal stents were predictors of poor prognosis (AU)

Long-term follow-up after percutaneous treatment of the unprotected left main stenosis in high risk patients not suitable for bypass surgery.

INTRODUCTION AND OBJECTIVES: Percutaneous coronary intervention is recommended in patients with unprotected left main stenosis non suitable for coronary artery bypass graft. Long-term follow-up of those patients remains uncertain. METHODS: All patients with de novo unprotected left main stenosis treated with stent implantation were consecutively enrolled. Percutaneous coronary intervention was indicated according to the standards of care, taking into account clinical and anatomical conditions unfavorable for coronary artery bypass graft. The primary end point was the occurrence of major adverse cardiac events, a composite of death, nonfatal acute myocardial infarction, or target lesion revascularization. RESULTS: Of 226 consecutive patients included, 202 (89.4%) were treated with drug-eluting stents. Mean age was 72.1 years, 41.1% had renal dysfunction, and mean Syntax score and EuroSCORE were 28.9 and 7.4, respectively. Angiographic and procedural success was achieved in 99.6% and 92.9% of patients. At 3 years, the rates of major adverse cardiac events, death, nonfatal acute myocardial infarction and target lesion revascularization were 36.2%, 25.2%, 8.4%, 8.0%, respectively. Target lesion revascularization was more frequently observed when ≥ 2 stents were implanted rather than a single stent (18.5% vs 5.8%, P=.03); and with bare metal stents rather than drug-eluting stents (13.0% vs 7.9%, P=.24). Definite stent thrombosis was observed in 2 patients (0.9%) and probable stent thrombosis in 7 (3.1%). Female sex, impaired left ventricular function, and use of bare metal stents were significantly related with all-cause mortality. CONCLUSIONS: High-risk patients with unprotected left main stenosis treated with percutaneous coronary intervention presented with a high rate of major adverse cardiac events at long-term follow-up. Female sex, impaired left ventricular function, and use of bare metal stents were predictors of poor prognosis.

Cardiogenic shock following administration of propofol and fentanyl in a healthy woman: a case report.

INTRODUCTION: Cardiogenic shock is very uncommon in healthy people. The differential diagnosis for patients with acute heart failure in previously healthy hearts includes acute myocardial infarction and myocarditis. However, many drugs can also depress myocardial function. Propofol and fentanyl are frequently used during different medical procedures. The cardiovascular depressive effect of both drugs has been well established, but the development of cardiogenic shock is very rare when these agents are used. CASE PRESENTATION: After a minor surgical intervention, a 32-year-old Caucasian woman with no significant medical history went into sudden hemodynamic deterioration due to acute heart failure. An urgent echocardiogram showed severe biventricular dysfunction and an estimated left ventricular ejection fraction of 20%. Extracorporeal life support and mechanical ventilation were required. Five days later her ventricular function had fully recovered, which allowed the progressive withdrawal of medical treatment. Prior to her hospital discharge, cardiac MRI showed neither edema nor pathological deposits on the delayed contrast enhancement sequences. At her six-month follow-up examination, the patient was asymptomatic and did not require treatment. CONCLUSION: Although there are many causes of cardiogenic shock, the presence of abrupt hemodynamic deterioration and the absence of a clear cause could be related to the use of propofol and fentanyl.

[Contrast-induced nephropathy]. / Nefropatía inducida por contraste.

Contrast-induced nephropathy is a major complication resulting from percutaneous coronary interventional procedures characterized by acute or subacute deterioration of renal function due to exposure to iodinated contrast medium that is associated with increased morbidity and mortality. Promoting factors for the development of nephropathy have been widely described in literature as well as hydration and pharmacological measures to prevent its development; However, few of them have shown evidence level A so far, hence a major research front remains open, not only in the prevention but also in the treatment of this pathology. In this article we review epidemiological and pathophysiological aspects of this complication, and various preventive and therapeutic modalities currently available.

[Coronary ectasia: prevalence, and clinical and angiographic characteristics]. / Ectasia coronaria: prevalencia, características clínicas y angiográficas.

INTRODUCTION AND OBJECTIVES: Coronary ectasia is characterized by the presence of diffuse dilation of the coronary vessels and is detected in 0.3-5.3% of angiographic studies. Our objective was to evaluate the prevalence of this condition, to analyze its clinical and angiographic characteristics, and to compare patients with ectasia and patients without it. PATIENTS AND METHOD: Coronary angiography was performed in 4.332 patients from October 1998 to June 2001. This population was divided in two groups, patients with and patients without ectasia and patients without ectasia. Angiographic and clinical variables were compared in these groups. RESULTS: The prevalence of ectasia was 3.39%. Most patients with ectasia (77.6%) had coronary stenosis. Ectasia affected a single vessel in 49.7%, most frequently the right coronary artery (132 patients), which also showed the greatest dilation. Most patients with ectasia were men (91.2%), smokers (56.5%), and younger than patients without ectasia (60.8 11.7 vs. 63.3 10.7 years; p = 0.01). They also had a lower prevalence of diabetes (22.4%) and previous revascularization procedures (8.2% angioplasty and 1.4% surgical revascularization).Logistical regression analysis showed that only male sex was associated to the presence of ectasia (OR = 3.33; 95% CI, 1.81-6.13) and that only diabetes was independently associated with absence of ectasia (OR = 0.65; 95% CI, 0.43-0.98). CONCLUSIONS: The prevalence of coronary ectasia in patients who underwent angiography was 3.4%. Coronary ectasia was prevalent in males and associated to the classic cardiovascular risk factors, except diabetes, a pathology that was less frequent than usual.

Ectasia coronaria: prevalencia, características clínicas y angiográficas / Coronary ectasia: prevalence, and clinical and angiographic characteristics

Introducción y objetivos. La ectasia coronaria constituye una dilatación difusa del vaso, que aparece en el 0,3-5,3 por ciento de las coronariografías. El objetivo de este artículo es conocer su prevalencia en nuestro medio, analizando sus características y comparándolas con las de la población sin ectasia. Pacientes y método. Desde octubre de 1998, los pacientes remitidos al laboratorio de hemodinámica para coronariografía que presentan coronarias ectásicas son incluidos en un registro prospectivo. Se analizan las distintas variables clínicas y angiográficas de los pacientes con y sin ectasia coronaria. Resultados. La prevalencia de ectasia fue del 3,39 por ciento. Un 77,6 por ciento presentaba estenosis coronarias significativas. Afectaba a un solo vaso en el 49,7 por ciento, siendo la coronaria derecha (n = 132) la más frecuentemente afectada y la que presentaba un mayor grado de dilatación. La mayoría de los sujetos con ectasia fueron varones (91,2 por ciento), fumadores (56,5 por ciento), más jóvenes que los pacientes sin ectasia (60,8 ñ 11,7 frente a 63,3 ñ 10,7 años; p = 0,01), y con menor prevalencia de diabetes (22,4 por ciento) y antecedentes de revascularización (8,2 por ciento angioplastia y 1,4 por ciento cirugía).En el modelo de regresión logística, el sexo masculino fue la única variable asociada a la presencia de ectasia (OR = 3,33; IC del 95 por ciento, 1,81-6,13), mientras que la diabetes se asoció de forma independiente con la ausencia de coronarias ectásicas (OR = 0,65; IC del 95 por ciento, 0,430,98). Conclusiones. La prevalencia de ectasia coronaria entre los pacientes sometidos a coronariografía por sospecha de cardiopatía isquémica es del 3,4 por ciento. Predomina en los varones y se asocia a los clásicos factores de riesgo, con excepción de la diabetes, una enfermedad que aparece con menor frecuencia de lo habitual (AU)